Head & Neck

Anatomy
 WEEK 1
Egg
• Fertilization occurs when sperm and
egg unite in the Fallopian tube
• Zygote refers to initial diploid cell
• Morula refers to a ball of cells that
is the result of cleavage
• Blastula refers to the ball of cells
once it develops a cavity called a
blastocoel
• Implantation occurs when the
blastula contacts the uterine wall
 WEEK 1
Egg
• Embryoblast refers to the inner
cell mass that will form the
embryo proper
• Trophoblast refers to the outer
cell mass that will form the
placenta
 WEEK 2
Egg
• Inner cell mass becomes a bilaminar disc
that consists of an epiblast and hypoblast
– Epiblast à three germ layers
– Hypoblast à disappears
• Amniotic cavity and yolk sac cavity form
• Primitive node and primitive streak on
the dorsal side of the embryo identifies
the caudal midline
 WEEK 3
Embryo
• Gastrulation refers to transition from single
sheet of cells to three distinct germ layers
– Ectoderm à epidermis, nervous system, teeth,
facial skeleton
• Surface ectoderm forms enamel
• Neural crest forms the rest of tooth
– Mesoderm à body skeleton, all muscles,
connective tissue
– Endoderm à lining of hollow organ systems
 WEEK 3
Embryo

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 WEEK 3
Embryo
 WEEK 4
Embryo
• Neurulation refers to the process where the flat
neural plate rolls into a neural tube
– Neural plate
– Neural fold
– Neural groove
– Neural tube
– Neural crest
• As the neural tube closes, the aortic arch vessels
and corresponding pharyngeal arches and somites
form in a cranial to caudal sequence
 WEEK 4
Embryo
• Stomodeum= primitive oral
cavity
• Optic placode= primitive eye
• Otic placode= primitive ear
• Blastopore= primitive anus

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 WEEK 4
Pharyngeal Arches
• Series of externally visible anterior tissue bands
lying under the early brain that give rise to head
and neck structures
• The sixth arch is “deep” and not visible
 WEEK 4
Pharyngeal Arches
• Each arch contains:
– an internal endodermal pouch
– a mesenchymal core (mesoderm and
neural crest with artery, nerve, muscle,
and cartilage)
– and an external ectodermal cleft
 WEEK 4
Pharyngeal Arches
Pharyngeal Cranial Skeleton/Cartilage Muscles Ligaments
Arch Nerve
1 V Meckel’s cartilage, MOM, anterior Sphenomandibular
(mandibular) Maxilla, mandible, digastric, mylohyoid, ligament
zygomatic, temporal, tensor veli palatini,
malleus, incus tensor tympani
2 VII Reichert’s cartilage, MFE, posterior Stylohyoid
(hyoid) stapes, styloid digastric, stylohyoid, ligament
process, upper half stapedius
of hyoid body and
lesser horns
3 IX Lower half of hyoid Stylopharyngeus
body and greater
horns
4 X Thyroid cartilage Cricothyroid, levator
veli palatini,
palatoglossus,
pharyngeal constrictors
6 (not visible) X Cricoid cartilage Laryngeal muscles
 WEEK 4
Pharyngeal Clefts, Pouches, & Placodes
Arch Cleft Pouch Placode
1 EAM Eustachian tube and Trigeminal ganglion
tympanic cavity
2 Cervical sinus Palatine tonsil Geniculate ganglion

3 Cervical sinus Thymus and inferior Inferior sensory

parathyroids ganglion of 9th cranial
nerve
4 Cervical sinus Superior paraythyroids and Inferior sensory
ultimobranchial body ganglion of 10th
(parafollicular cells of cranial nerve
thyroid)
 WEEK 4
Pituitary Gland
• Stomodeum à Rathke’s pouch à anterior pituitary
• Forebrain à diencephalon à posterior pituitary

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 WEEK 4
Tongue
• Tongue has unique segmented innervation pattern because it
is developed from four separate arches

Arch Nerve Function Area of Tongue

1 V Sensory Anterior 2/3

2 VII (chorda Taste Anterior 2/3

tympani)
3 IX Sensory and taste Posterior 1/3

4 X Sensory, taste, and Base

motor (palatoglossus)
* XII Motor (everything
else)
 WEEK 4
Thyroid Gland
• Descends through the neck carrying with it the thyroglossal
duct, which connects to the foramen cecum on the tongue
• An undescended thyroid may sit at the base of the tongue as a
lingual thyroid
 WEEK 6
Ear
• Ear develops from 6 auricular hillocks from the first and second
arches
• Retinoic acid (Accutane) can cause first and second arch defects
– Microtia= small ear
– Micrognathia= small mandible
 WEEK 4-8
Lip & Palate
• Cleft= failure of fusion
• Cleft lip
– 4 to 6 weeks in utero
– MNP & MP anteriorly
• Cleft palate
– 6 to 8 weeks in utero
– MNP & MP posteriorly

MNP= medial nasal prominence

LNP= lateral nasal prominence
MP= maxillary prominence
 DiGeorge Syndrome
Patient

Male, 2 years old

CATCH 22
Chief Complaint
Cardiac abnormalities
Parent: “My son has difficulty feeding
and talking.”
Abnormal facies
Thymic aplasia
Background and/or Patient History
Cleft palate
Hypocalcemia
Current Findings
22q11 deletion
Clinical exam reveals unrepaired cleft
palate, short philtrum, small mandible,
and hypertelorism
Head & Neck
Anatomy
 Skull
• The skull is a bony structure that forms a protective cavity for the brain and
supports the face
• Sutures are fibrous joints between the skull bones that permit brain
growth during childhood and adolescence and fuse together in adulthood
• Neural crest forms anterior skull, paraxial mesoderm forms posterior skull
 Skull
• The skull is a bony structure that forms a protective cavity for the brain and
supports the face
• Sutures are fibrous joints between the skull bones that permit brain
growth during childhood and adolescence and fuse together in adulthood
• Bones of the skull can be divided into those of the cranium and the face
 Cranium (or Neurocranium)
• Subdivided anatomically into a roof and a base
• Calvarium is comprised of frontal, parietal, and occipital bones
• Cranial base is comprised of frontal, ethmoid, sphenoid,
temporal, parietal, and occipital bones

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 Face (or Viscerocranium)
• Supports soft tissues of the face and subsequently determines our facial
appearance
• Fourteen individual bones fuse to house the orbits, nasal and oral cavities,
and sinuses
• Comprised of zygomatic, maxilla, nasal, lacrimal, palatine bones, ethmoid
(superior and middle nasal conchae), inferior nasal conchae, vomer, and
mandible

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 Fontanelles
• Fontanelles are incompletely fused joints
that manifest as membranous gaps between
the skull bones
• Frontal fontanelle= located at junction of
coronal and sagittal suture
• Occipital fontanelle= located at junction of
lambdoid and sagittal suture
 Sutures
• Sutures are immovable fibrous joints unique to the skull
• Frontal/metopic suture= closes within 3-9 months after
birth
• Coronal suture= fuses frontal bone with two parietal
bones
• Sagittal suture= fuses both parietal bones
• Squamous suture= fuses parietal bone with temporal
bone
• Lambdoid suture= fuses occipital bone with two parietal
bones
• Bregma= where coronal and sagittal sutures intersect
• Lambda= where sagittal and lambdoid sutures intersect
 Craniosynostosis
• Involves premature closure of fontanelles and
sutures
• Scaphocephaly= caused by early closure of
sagittal suture
• Brachycephaly= caused by early closure of
coronal and lambdoid sutures
• Plagiocephaly= caused by early closure of
coronal and lambdoid sutures on one side of
the skull
 Sinuses
• Sinuses develop as diverticula of the lateral
nasal wall and extend into the frontal,
ethmoid, sphenoid, and maxilla bones
• Primary function is to reduce weight of the
front of the skull
 Mandible
• Because the angle of the mandible adapts to changes in the alveolar
process, the angle varies with age-related changes in dentition
• At birth, the mandible is without teeth
• In children, the mandible bears the small deciduous teeth
• In adults, the mandible bears the permanent teeth
• Edentulous mandibles are characterized by resorption of the alveolar
process
 Lines
• Principle lines of force are the strongest areas of the skull and
develop along the lines of force in response to local mechanical
stress
• Principle lines of fracture (LeFort fracture lines) are the weakest
areas of the skull and are common sites of fractures
 Orbital Bones
• Frontal bone
• Maxillary bone
• Palatine bone
• Lacrimal bone
• Ethmoid bone
• Sphenoid bone
• Zygomatic bone

“FM PLESZ”
 Ethmoid Bone
• Crista galli= falx cerebri of dura
mater attaches
• Uncinate process= sickle-shaped
extension that directs sinus
drainage to the middle meatus
• Cribriform plate= CN I passes
through
• Superior and middle nasal
conchae= curled shelf of bone that
directs airflow in the nose
 Sphenoid Bone
• Sella turcica= saddle-shaped
depression that houses the pituitary
gland
• Clinoid processes= four bony processes
that surround the sella turcica, attach
to dura mater
• Lesser wing= part of anterior cranial
fossa
• Greater wing= part of middle cranial
fossa
 Nasal Septum
• Vertical wall separating the
left and right nasal airways
– Septal cartilage
– Perpendicular plate of
ethmoid bone
– Vomer bone
 Nasal Meatuses
• Superior meatus= opening to sphenoid
sinus, posterior ethmoid sinus,
sphenopalatine foramen
• Middle meatus= opening to anterior
and middle ethmoid sinuses, maxillary
sinus, and frontal sinus via semilunar
hiatus
• Inferior meatus= nasolacrimal duct
Head & Neck
Anatomy
 Foramen
• Opening that allows vital structures to pass from one part of
the body to another
 Frontal
• Supraorbital foramen= supraorbital nerve (V1), artery, and vein
 Maxilla
• Infraorbital foramen= infraorbital nerve (V2), artery, and vein
 Mandible
• Mental foramen= mental nerve (V3), artery, and vein
 Ethmoid
• Cribriform plate= CNI
 Sphenoid
• Optic canal= CNII, ophthalmic artery
• Superior orbital fissure= CNIII, CNIV,
V1, CNVI
• Foramen rotundum= V2
• Foramen ovale= V3, lesser petrosal
nerve
• Foramen spinosum= middle meningeal
artery
• Foramen lacerum= greater petrosal
nerve & deep petrosal nerve (Vidian
nerve)

“Standing Room Only”

 Temporal
• Carotid canal= internal carotid
artery
• Internal auditory meatus= CNVII,
VIII
• Jugular foramen= CNIX, X, XI
 Occipital
• Hypoglossal canal= CNXII
• Foramen magnum= spinal
cord, spinal and vertebral
arteries
Head & Neck
Anatomy
 Fossa
• Temporal fossa
• Infratemporal fossa External

• Pterygopalatine fossa
• Anterior cranial fossa
• Middle cranial fossa Internal
• Posterior cranial fossa
 Temporal Fossa
• Superior border= superior temporal line
• Posterior border= superior temporal line
• Inferior border= zygomatic arch
• Anterior border= frontal process of zygoma
• Floor= frontal, greater wing of sphenoid, parietal, squamous portion of temporal
• Contents= temporalis, superficial temporal artery, auriculotemporal nerve
 Infratemporal Fossa
• Lateral border= coronoid process and ramus
• Medial border= lateral pterygoid plate
• Superior border= greater wing of sphenoid (infratemporal crest)
• Inferior border= medial pterygoid muscle
• Anterior border= maxilla
• Posterior border= condyle and styloid process, articular eminence
• Contents= MOM, pterygoid plexus, maxillary artery, PSA nerve, mandibular nerve (IAN, buccal,
auriculotemporal, lingual), chorda tympani, otic ganglion
 Pterygopalatine Fossa
Surface Border Opening Contents
Lateral Pterygomaxillary fissure PSA nerve
Maxillary artery
Medial Perpendicular plate of palatine Sphenopalatine foramen Nasopalatine nerve Sphenopalatine
bone artery
Superior Greater wing of sphenoid Inferior orbital fissure Infraorbital nerve & artery
Zygomatic nerve
Inferior Pyramidal process of palatine Greater palatine canal Greater & lesser palatine nerve &
bone artery
Anterior Maxilla
Posterior Pterygoid process of sphenoid Foramen rotundum V2
bone
Vidian/pterygoid canal Vidian nerve/nerve of pterygoid canal

Pharyngeal canal Pharyngeal nerve & artery

Pterygopalatine Fossa
 Cranial Fossae
• Anterior
– Frontal, ethmoid, lesser wing of sphenoid
– Lies over nasal cavity and orbit
– Houses frontal lobes
• Middle
– Greater wing of sphenoid, temporal
– Houses pituitary gland and temporal lobes
• Posterior
– Occipital
– Houses brainstem and cerebellum
Head & Neck
Anatomy
 Fascia
• Thin casing of connective tissue beneath the skin that
surrounds and holds every organ, blood vessel, bone, nerve
fiber, and muscle in place
– Superficial= loose connective tissue under the dermis
– Deep= dense connective tissue that surrounds muscles, bones,
nerves, and blood vessels
– Visceral= suspends organs within their cavities
 Superficial Cervical Fascia
• Located between dermis and deep cervical fascia
• Surrounds platysma and superficial vessels and nerves
 Deep Cervical Fascia
• Investing= surrounds SCM and trapezius
muscles
• Visceral= surrounds neck viscera
– Pretracheal= anterior
– Buccopharyngeal= posterior
• Prevertebral= surrounds vertebral muscles,
cervical plexus, and brachial plexus
• Carotid sheath= surrounds common carotid
artery, IJV, vagus nerve, and deep cervical
lymph nodes
 Fascial Spaces
• Deep fascia encloses potential spaces into which infections of
dental origin can spread
• Infection will always follow the path of least resistance (bone
density, muscle attachment)
 Cardinal Signs of Infection
• Dolor= pain
• Tumor= swelling
• Calor= heat
• Rubor= redness
• Functio laesa= loss of function (trismus, dyspnea, dysphagia)
 Vital Signs of Infection
• Temperature >100˚F
• Blood pressure >120/80
• Pulse >100
• Respiratory rate >16
• Lymphadenopathy
 Primary Spaces
• Canine
• Buccal
• Submandibular
• Submental
• Sublingual
• Vestibular
 Secondary Spaces
• Submasseteric
• Pterygomandibular
• Superficial/Deep Temporal
• Parapharyngeal
• Retropharyngeal
• Danger
• Prevertebral
• Periorbital
 Vestibular Space
• Lies between cortical bone and mucoperiosteum
• Most common site for spread of dental infections that break out of
alveolar bone
• Path of least resistance from a specific tooth is determined by
thickness of bone overlying site of infection and relationship of
bone perforation to muscle attachments
 Canine/Infraorbital Space
• Lies between levator anguli oris and levator labii superioris muscles
superficial to canine fossa of maxilla
• Infection presents with swelling of vestibule, upper lip, and lower
eye lid
• Usual dental source is maxillary canines or incisors
 Periorbital Space
• Lies between orbicularis oculi and orbital septum
• Infection presents with redness and swelling of eyelid, may
obstruct vision
• Path of least resistance is from canine space
 Buccal Space
• Lies between buccinator and skin, location of the buccal pad
• Infection presents with marked cheek swelling
• Usual dental source is premolars or molars
 Sublingual Space
• Swelling would be evident in the floor of the mouth
• Usual dental source is mandibular incisor, canine, premolar or
first molar whose roots are ABOVE attachment of mylohyoid to
the mylohyoid line
 Submandibular Space
• Swelling would be evident at submandibular triangle
• Usual dental source is mandibular second or third molar whose
roots are BELOW attachment of mylohyoid to the mylohyoid line
 Submental Space
• Swelling would be evident at below chin between anterior
bellies of digastric
• Usual dental source is mandibular incisor
 Ludwig’s Angina
• Swelling in all perimandibular
spaces
– Elevates floor of mouth
– Displaces tongue upwards and
backwards
– Blocks oropharynx
– Compromises the airway
• Can spread to mediastinum via
fascial spaces of neck
 Superficial & Deep Temporal
• Infection presents with lateral “hourglass” facial swelling
• Usual dental source is maxillary second or third molar
 Submasseteric/Masseteric Space
• Lies between masseter and ramus
• Infection frequently involves trismus
• Usual dental source is impacted third molars
 Pterygomandibular Space
• Lies between medial pterygoid and mandibular ramus
• Contains sphenomandibular ligament, inferior alveolar nerve &
vessels, lingual nerve, and chorda tympani
• Usual dental source is mandibular third molars or
contaminated needle
• HIGH RISK due to close proximity to lateral pharyngeal space
Masticator Space
 Parapharyngeal/Lateral Pharyngeal Space
• Lies between masticator space anteriorly
and retropharyngeal space posteriorly
• Usual dental source is mandibular third
molar
• VERY HIGH RISK due to close proximity to
and continuity with retropharyngeal space
 Retropharyngeal Space
• Lies between buccopharyngeal fascia and
alar fascia
• Spans from base of skull to mediastinum
• VERY HIGH RISK due to highway of
infection spread
 Danger Space
• Lies between alar fascia and prevertebral
fascia
• Spans from base of skull to posterior
mediastinum and diaphragm
• EXTREMELY HIGH RISK due to highway of
infection spread
 Parotid Space
• Infection presents with medial bulge of lateral pharyngeal wall,
pain, and trismus
• Usually not involved in spread of dental infections, but rather
caused by parotitis, sialolithiasis, or Sjogren’s syndrome
 Treatment
• Extraction or pulpectomy
• Incision and drainage (decrease bacterial load, increase blood
flow to site)
• Antibiotic coverage (if diffuse swelling, involved fascial spaces,
fever, tachycardia)
Head & Neck
Anatomy
 V3
Muscles of Mastication
• Formed from paraxial mesoderm of 1st arch
• Originate from skull and insert into mandible
 Masseter
• Origin= zygomatic arch
• Insertion= lateral surface of ramus
and angle
• Action= elevates mandible,
superficial fibers protrude, deep
fibers retract, moves mandible
toward same side
 Temporalis
• Origin= temporal fossa
• Insertion= coronoid process
• Action= elevates mandible,
posterior fibers retract mandible
 Medial Pterygoid
• Origin= maxillary tuberosity
(superficial) and medial surface of
lateral pterygoid plate (deep)
• Insertion= medial surface of ramus
and angle
• Action= elevates and protrudes
mandible, moves mandible toward
opposite site
 Lateral Pterygoid
• Origin= infratemporal crest
(superior head) and lateral surface
of lateral pterygoid plate (inferior
head)
• Insertion= articular disc (superior
head) and pterygoid fovea (inferior
head)
• Action= depresses and protrudes
mandible, moves mandible toward
opposite site
Masticator Space
Head & Neck
Anatomy
 CN VII
Muscles of Facial Expression
• Formed from paraxial mesoderm of 2nd arch
• Originate from bone
• Insert into dermis
• Generally named by action or location
 Epicranial Muscles
• Occipitofrontalis/Epicranius
• Temporoparietalis
 Occipitofrontalis
• Long and wide muscle spanning from
eyebrows to the back of the head
• Epicranial aponeurosis connects frontal
and occipital bellies and also forms the
middle layer of the scalp
• Pulls the forehead up and retracts the
scalp
 Temporoparietalis
• Sits over the temporalis muscle
 Smiling Muscles
• Zygomaticus Major (2)
• Zygomaticus Minor (2)
• Orbicularis Oculi (2)
• Levator Labii Superioris (2)
• Levator Anguli Oris (2)
• Risorius (2)
 Zygomaticus Major
• Origin= zygomatic bone
• Insertion= modiolus
• Action= pulls up the corners of the mouth
for smiling, laughing, and displaying teeth
 Zygomaticus Minor
• Pulls up the corners of the mouth
• For smiling, laughing, and displaying teeth
 Orbicularis Oculi
• Eye sphincter muscles that closes the
eyelids
• Palpebral portion à blinking
• Orbital portion à tight closure
• Also protects the cornea
Levator Labii Superioris
• These broad flat muscles elevate the
upper lip
 Levator Anguli Oris
• These deep muscles raise the corners of
the mouth medially
• Inserts into the modiolus
 Risorius
• Pulls lip laterally without displaying teeth
• Inserts into the modiolus
 Frowning Muscles
• Orbicularis Oris (1)
• Depressor Anguli Oris (2)
• Depressor Labii Inferioris (2)
• Platysma (2)
• Mentalis (1)
• Corrugator Supercilii (2)
• Procerus (1)
• Orbicularis Oculi (2)
 Orbicularis Oris
• Mouth sphincter muscle that puckers the
lips, compresses lips against teeth, and
used in speech
• Blends with the buccinator muscle
laterally
• Inserts into the modiolus
 Depressor Anguli Oris
• Pulls down corner of the mouth
• Inserts into the modiolus
Depressor Labii Inferioris
• Pulls down lower lip
 Platysma
• Superficial muscle that pulls down the lips
and mouth and wrinkles the skin on
portions of the lower face
• Overlaps sternocleidomastoid muscle
 Mentalis
• Deep triangular muscle that pouts lower
lip
• Mentalis strain on lip closure is a sign of
lip incompetence
• Can displace a lower denture
 Corrugator Supercilii
• Draws eyebrows together
 Procerus
• Pyramid-shaped muscle that wrinkles
bridge of nose
 Other Muscles
• Buccinator
• Nasalis
 Buccinator

• Origin= maxillary and

mandibular processes
• Insertion= modiolus
• Action= tenses the cheek to
keep food between teeth
• Overlain by buccal fat pad
• Pierced by parotid duct
 Nasalis
• Flares nostrils and compresses
nose
Head & Neck
Anatomy
 CN V3, VII, XI, C1-3
Neck Muscles
• The neck is divided into two main triangles
(anterior and posterior) for localizing
anatomical structures and pathological
conditions
• Both triangles are separated by the SCM
 Submandibular
Triangle
• Framed by both bellies of digastric and
inferior border of mandible
• Contains submandibular gland,
submandibular lymph nodes, facial
artery and vein, CNXII, and mylohyoid
nerve
 Submental Triangle
• Framed by midline, anterior belly of
digastric, and hyoid bone
• Contains submental lymph nodes and
beginning of anterior jugular veins
 Muscular Triangle
• Framed by midline, superior belly of
omohyoid, and SCM
• Contains infrahyoid muscles, thyroid
and parathyroid glands
 Carotid Triangle
• Framed by superior belly of omohyoid,
posterior belly of digastric, and SCM
• Contains carotid sheath, CNXII, and
ansa cervicalis
• Carotid artery pulse is palpable here
 Posterior Triangle
• Subdivided into occipital triangle above
inferior belly of omohyoid, and
subclavian triangle below
• Contains CNXI, branches of cervical
plexus, phrenic nerve, subclavian artery
and vein, EJV, and roots of brachial
plexus
• Floor consists of splenius capitis,
levator scapulae, and anterior, middle,
and posterior scalenes
 Suprahyoids
• Geniohyoid
• Mylohyoid
• Anterior belly of digastric
• Posterior belly of digastric
• Stylohyoid

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 C1
Geniohyoid
• Origin= genial tubercles of
mandible
• Insertion= hyoid bone
• Action= elevates hyoid bone
and tongue during
swallowing
 V3
Mylohyoid
• Origin= mylohyoid line of
mandible
• Insertion= hyoid bone
• Action= elevates hyoid bone
and tongue
• Forms the muscular floor of
mouth
 V3
Anterior Belly of Digastric
• Origin= digastric fossa of
mandible
• Insertion= intermediate
tendon (attached to hyoid)
• Action= elevates hyoid or
assists lateral pterygoid in
depressing mandible
 CN VII
Posterior Belly of Digastric
• Origin= mastoid process of
temporal bone
• Insertion= intermediate
tendon (attached to hyoid)
• Action= elevates hyoid or
assists lateral pterygoid in
depressing mandible
 CN VII
Stylohyoid
• Origin= styloid process of
temporal bone
• Insertion= greater horn of
hyoid bone
• Action= elevates hyoid bone
during swallowing
 Infrahyoids
• Thyrohyoid
• Omohyoid
• Sternothyroid
• Sternohyoid

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 C1
Thyrohyoid
• Origin= thyroid cartilage of
larynx
• Insertion= hyoid bone
• Action= elevates thyroid and
depresses hyoid bone
 C1-C3
Omohyoid
• Origin= scapula also known
as the shoulder blade
• Insertion= hyoid bone
• Action= depresses larynx
and hyoid bone
• Superior and inferior bellies
connected via intermediate
tendon
 C1-C3
Sternothyroid
• Origin= manubrium of the
sternum
• Insertion= thyroid cartilage
• Action= depresses thyroid
cartilage
 C1-C3
Sternohyoid
• Origin= manubrium of the
sternum
• Insertion= hyoid bone
• Action= depresses hyoid
bone
 CN XI
Sternocleidomastoid
• Origin= manubrium of the sternum
and the clavicle
• Insertion= mastoid process of the
temporal bone
• Action= rotates and flexes the neck
 CN XI
Trapezius
• Origin= spine and occipital
protuberance
• Insertion= scapula
• Action= rotates, elevates, and
depresses the shoulder
• Only muscle of the upper limb supplied
by a cranial nerve
Head & Neck
Anatomy
 CN X, XII
Tongue Muscles
• Formed from paraxial mesoderm that eventually becomes
occipital somites
 Extrinsic Muscles
• Originate outside the tongue and attach to it
• Function to alter the position of the tongue
 Extrinsic Muscles
• Hyoglossus
• Genioglossus
• Palatoglossus
• Styloglossus

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 CN XII
Hyoglossus
• Origin= hyoid bone
• Insertion= tongue
• Action= depresses the tongue
 CN XII
Genioglossus
• Origin= genial tubercles
• Insertion= tongue
• Action= protrudes the tongue
 CN XII
Styloglossus
• Origin= styloid process of
temporal bone
• Insertion= tongue
• Action= retracts the tongue
 CN X
Palatoglossus
• Origin= palatine aponeurosis
• Insertion= tongue
• Action= elevates back part of
tongue
 CN XII
Intrinsic Muscles
• Longitudinal (superior & inferior)
• Transverse
• Vertical
• Attach entirely within the tongue
• Function to alter the shape of the tongue
Head & Neck
Anatomy
 CN V3, X
Soft Palate Muscles
• Palatopharyngeus
• Musculus uvulae
• Tensor veli palatini
• Levator veli palatini
• Salpingopharyngeus
 CN X
Palatopharyngeus
• Origin= palatine aponeurosis
• Insertion= upper border of
thyroid cartilage and
pharyngeal wall
• Action= pulls pharynx and
larynx upward
 CN X
Musculus Uvulae
• Origin= palatine aponeurosis
• Insertion= uvula
• Action= shortens and
broadens the uvula to help
close nasopharynx during
swallowing
 V3
Tensor Veli Palatini
• Origin= scaphoid fossa and
cartilaginous part of auditory
tube
• Insertion= palatine aponeurosis
• Action= tenses the soft palate,
opens the auditory tube
• Its tendon hooks around the
pterygoid hamulus and forms
palatine aponeurosis across the
soft palate
 CN X
Levator Veli Palatini
• Origin= petrous part of
temporal bone and
cartilaginous part of auditory
tube
• Insertion= palatine aponeurosis
• Action= elevates the soft palate
to close off nasopharynx during
swallowing
 CN X
Salpingopharyngeus
• Origin= cartilaginous part of
auditory tube
• Insertion= upper border of
thyroid cartilage and
pharyngeal wall
• Action= also helps to equalize
air pressure
Head & Neck
Anatomy
 CN IX, X
Pharyngeal & Laryngeal Muscles
• Pharynx
– Outer circular layer
– Inner longitudinal layer
• Larynx
– Posterior cricoarytenoid
– Oblique & transverse arytenoids
– Cricothyroid
– Thyroarytenoid
 CN X
Outer Circular Layer
• Superior constrictor= attaches with
buccinator muscle at pterygomandibular
raphe
• Middle constrictor
• Inferior constrictor
• Function to involuntarily constrict
pharynx to propel bolus downward
during swallowing
 CN IX, X
Inner Longitudinal Layer
• Salpingopharyngeus (X)
• Palatopharyngeus (X)
• Stylopharyngeus (IX)
• Function to involuntarily
elevate the pharynx during
swallowing and speaking
 CN X
Posterior Cricoarytenoid
• Origin= cricoid cartilage
• Insertion= arytenoid cartilage
• Action= abduct the vocal cords
away from the midline thereby
opening the airway at the glottis
 CN X
Oblique & Transverse Arytenoids
• Origin= arytenoid cartilage
• Insertion= arytenoid cartilage
• Action= adduct the vocal cords toward
the midline thereby closing the larynx
during coughing or swallowing
 CN X
Cricothyroid
• Origin= cricoid cartilage
• Insertion= thyroid cartilage
• Action= tenses and elongates vocal
folds to increase pitch
• Only laryngeal muscle innervated by
superior laryngeal nerve instead of
recurrent laryngeal nerve
 CN X
Thyroarytenoid
• Origin= thyroid cartilage
• Insertion= arytenoid cartilage
• Action= reduces tension and
shortens vocal folds to decrease
pitch
Head & Neck
Anatomy
 CN V3, VII
Ear Muscles
• Tensor tympani
• Extrinsic auricular muscles
• Intrinsic auricular muscles
 V3
Tensor Tympani
• Origin= bony part of auditory tube
• Insertion= malleus
• Action= tenses the tympanic
membrane to dampen loud sound to
protect against hearing damage
 CN VII
Extrinsic Auricular Muscles
• Superior= largest
• Posterior
• Anterior= smallest
• Function to alter the position the
outer ear
 CN VII
Intrinsic Auricular Muscles
• Helicis major
• Helicis minor
• Tragicus
• Antitragicus
• Oblique auricular
• Transverse auricular
• Function to alter the shape of the ear
Head & Neck
Anatomy
 CN III, IV, VI
Extraocular Eye Muscles
• Levator palpebrae superioris
• Superior oblique
• Inferior oblique
• Lateral rectus
• Superior rectus
• Inferior rectus
• Medial rectus
 CN III
Levator Palpebrae Superioris
• Origin= lesser wing of sphenoid
• Insertion= upper eyelid
• Action= elevates upper eyelid
 CN IV
Superior Oblique
• Origin= sphenoid bone (just
medial to optic canal)
• Insertion= lateral surface of
eyeball
• Action= abducts, depresses,
and intorts the eye
• Hooks around trochlea
 CN III
Inferior Oblique
• Origin= maxilla
• Insertion= lateral surface of
eyeball
• Action= abducts, elevates,
and extorts the eye
 CN VI
Lateral Rectus
• Origin= annulus of Zinn
• Insertion= lateral surface of
eyeball
• Action= abducts the eye

SO4 LR6
 CN III
Superior Rectus
• Origin= annulus of Zinn
• Insertion= superior surface of
eyeball
• Action= adducts, elevates,
and intorts the eye
 CN III
Inferior Rectus
• Origin= annulus of Zinn
• Insertion= inferior surface of
eyeball
• Action= adducts and
depresses the eye
 CN III
Medial Rectus
• Origin= annulus of Zinn
• Insertion= medial surface of
eyeball
• Action= adducts the eye
 CN III, V1
Intraocular Eye Muscles
• Ciliary muscle
• Sphincter pupillae
• Dilator pupillae
 CN III
Ciliary Muscle
• Helps in accommodation for near
vision
• PSNS fibers of oculomotor nerve
via short ciliary nerves
 CN III
Sphincter Pupillae
• Circular fibers
• Constricts pupil= miosis
• PSNS fibers of oculomotor nerve
via short ciliary nerves
 CN V1
Dilator Pupillae
• Radial fibers
• Dilates pupil= mydriasis
• SNS fibers of V1 via long ciliary nerves
Head & Neck
Anatomy
 Nervous
System

CNS PNS

Spinal
Brain Sensory Motor
Cord

Visceral
Forebrain Midbrain Hindbrain Somatic Visceral Somatic
(ANS)

SNS PSNS
 CN I
Olfactory Nerve
• Special visceral sensory for smell
• Olfactory receptor neurons à olfactory bulb à olfactory tract
à temporal lobe
 CN II
Optic Nerve
• Special somatic sensory for vision
• Retina à optic nerve à optic chiasma à optic tract à lateral
geniculate body à occipital lobe
• Women are better at shade matching due to more cone cells
 CN III
Oculomotor Nerve
• Somatic motor to extraocular muscles
• PSNS to smooth muscle associated with pupil constriction
– Edinger-Westphal nucleus à ciliary ganglion à ciliary muscle &
pupillary sphincter muscle
 CN IV
Trochlear Nerve
• Somatic motor to superior oblique
• Only cranial nerve that arises from the dorsal side of brainstem
 CN V
Trigeminal Nerve
• Sensory information from orofacial region
• Somatic motor to the muscles of mastication
 Ophthalmic Division (V1)
• Frontal nerve= forehead
– Supraorbital
– Supratrochlear= skin above medial canthus
• Lacrimal nerve= skin above lateral canthus
• Nasociliary nerve= nose and eye
– Long ciliary= eye
– Posterior ethmoid
– Anterior ethmoid= external nasal
– Infratrochlear= skin adjacent to medial canthus
 Maxillary Division (V2)
• Sphenopalatine nerve= exits via sphenopalatine
foramen
• Pharyngeal nerve= exits via pharyngeal canal
• Greater and lesser palatine nerves= via greater
palatine canal and associated foramina
• PSA nerve= via pterygomaxillary fissure and pierces
posterior maxilla above the tuberosity
• Zygomatic nerve
– Zygomaticotemporal
– Zygomaticofacial
• Infraorbital nerve= via inferior orbital fissure
– MSA branches off, then buries into infraorbital canal
– ASA branches off, and finally exits through infraorbital
foramen
 Mandibular Division (V3)
• Auriculotemporal nerve= sensory from TMJ and anterior ear,
splits around middle meningeal artery
• Long buccal nerve= sensory from buccal gingiva of
mandibular molars
• Lingual nerve= sensory from anterior 2/3 of tongue, floor of
mouth, and lingual gingiva
• Inferior alveolar nerve= sensory from mandibular teeth
– Mental branch= through mental foramen, facial gingiva of
anterior teeth, lower lip, and chin
– Incisive branch= continuation within mandibular canal,
anterior tooth pulps
– Mylohyoid branch= splits off before IAN enters mandibular
foramen, motor to mylohyoid
• Medial pterygoid nerve= motor to medial pterygoid muscle
and the two tensor muscles
 CN VI
Abducens Nerve
• Somatic motor to lateral rectus
 CN VII
Facial Nerve
• Sensory information from ear, tongue, and palate
• Somatic motor to the muscles of facial expression
• Chorda tympani to submandibular and sublingual glands and
greater petrosal nerve to accessory glands (PSNS)

To Zanzibar By Motor Car

 CN VIII
Vestibulocochlear Nerve
• Special somatic sensory for hearing and balance
• Vestibular branch detects balance, cochlea detects hearing
 CN IX
Glossopharyngeal Nerve
• Somatic and visceral sensory from posterior third of tongue via lingual branch
• Sensory end of gag reflex
• Somatic motor to stylopharyngeus muscle
• Hering’s nerve= baroreceptors and chemoreceptors (PSNS and SNS)
• Lesser petrosal nerve to parotid gland (PSNS)
 CN X
Vagus Nerve
• Sensory information from laryngeal mucosa below vocal cords
• Visceral sensory and motor from and to heart, lungs, and digestive tract
• Somatic motor to most pharynx, larynx, and soft palate muscles
• Motor end of gag reflex
• Baroreceptors and chemoreceptors (PSNS and SNS)
 CN XI
Spinal Accessory Nerve
• Somatic motor to SCM and trapezius
• Spinal root originates from C1-C5 and ascends into skull via
foramen magnum and exits via jugular foramen
 CN XII
Hypoglossal Nerve
• Somatic motor to tongue muscles except palatoglossus
Head & Neck
Anatomy
 Salivary Gland Anatomy
• Serous acinus
• Mucous acinus
• Mixed acinus
• Myoepithelial cell
• Intercalated duct
• Striated duct
 Parotid Gland
• Stensen’s duct
• Serous secretion
• CN IX à inferior salivatory nucleus à lesser
petrosal nerve
• Wraps around posterior border of ramus
• Largest salivary gland
• Within the parotid gland:
– Branches of CNVII
– Retromandibular vein
– Termination of external carotid artery
– Auriculotemporal nerve
 Submandibular Gland
• Wharton’s duct
• Mixed secretion
• CN VII à superior salivatory nucleus
à chorda tympani
• Produces majority of saliva
• Most common to have sialolith
• Wraps around posterior border of
mylohyoid
 Sublingual Gland
• Bartholin’s duct
• Mucous secretion
• CN VII à superior salivatory nucleus
à chorda tympani
• Located above mylohyoid muscle
 Visceral Motor Pathways
Gland Nerve Fibers Origin Nerve Ganglion Hitchhike
Lacrimal, CN VII PSNS Superior Greater Pterygopalatine Lacrimal (V1) and
Nasal, salivatory petrosal Zygomatic (V2)
Palatine, & nucleus
Pharyngeal
Submandibular CN VII PSNS Superior Chorda tympani Submandibular Lingual (V3)
& Sublingual salivatory
nucleus
Parotid CN IX PSNS Inferior Lesser petrosal Otic Auriculotemporal
salivatory (V3)
nucleus
Pupil* CN III PSNS Edinger- Inferior branch Ciliary Ophthalmic (V1)
Westphal
nucleus
Mucous -- SNS Internal Deep petrosal Pterygopalatine Lacrimal (V1) and
carotid Zygomatic (V2)
plexus